Chapter 52 - Seizure Disorders and Spasticity

Question 1

Phenobarbital

Answer 1

Class: Barbiturate

Question 2

Phenobarbital 
MOA: 
Uses:
AE: 
Other:

Answer 2

MOA: Depresses the CNS by inhibiting the conduction of impulses in the ascending reticular activating system, thus depressing the cerebral cortex and cerebellar function
Uses: Sedative and antiepileptic agent in the treatment of generalized tonic-clonic and partial seizures
AE: CNS depression, cognitive impairment with sedation, somnolence, agitation, confusion, vertigo, nightmares, Stevens-Johnson syndrome
BBW: SI
Other: Parenteral form used to control acute seizures; give bolus dose and get drug to therapeutic level quicker if used in IV dose; do not abruptly stop taking med

Question 3

diazepam (Valium)

Answer 3

Class: Benzodiazepines

Question 4

diazepam (Valium)
MOA; 
Uses:
Contra:
Antidote:

Answer 4

MOA: Exact action unknown; believed to act primarily on the limbic system and reticular formation to produce skeletal muscle relaxation
Uses: As antidepressants, antiepileptics, or skeletal muscle relaxants; treatment of severe recurrent convulsive seizures and status epilepticus
Contra: Acute-angle glaucoma, shock, coma, acute alcohol intoxication, and pregnancy
Antidote: flumazenil (Romazicon)

Question 5

gabapentin (Neurontin)

Answer 5

Class: Gamma-Aminobutyric Acid Structural Analogs

Question 6

gabapentin (Neurontin)
MOA:
Uses:
AE:
Pt. Education:

Answer 6

MOA: It has the ability to inhibit postsynaptic responses and block post-tetanic potentiation
Uses: Partial seizures, postherapetic neuralgia (nerve pain that occurs after certain infections)
AE: CNS depression –> dizziness, somnolence, insomnia, ataxia; pruritis, dry mouth, dyspepsia, SI, N/V
Pt. Education: Do not operate heavy machinery or drive with CNS depression, do not abruptly stop medication

Question 7

levetiracetam (Keppra)

Answer 7

Class: Pyrrolidine Derivatives

Question 8

levetiracetam (Keppra)
MOA:
Use:
AE:

Answer 8

MOA: Is not chemically related to other AEDs; MOA unknown –> inhibits neuronal firing but does not affect excitability
Use: Seizures
AE: Drowsiness, dizziness, fatigue; decrease RBC and WBC counts, double vision, amnesia, anxiety, emotional lability, hostility

Question 9

phenytoin (Dilantin)

Answer 9

Class: Hydantoins

Question 10

phenytoin (Dilantin) 
MOA: 
Use:
AE:
Admin:
Pt. Education:
Long term risks:

Answer 10

MOA: Stabilizes the neuronal membrane by delaying the influx of sodium ions into the neurons and preventing the excitability causes by excessive stimulation
Use: Treating all types of epilepsy except absence seizures
AE: CNS depression, gingival hyperplasia, skin rash, cardiac dysrhythmias, hypotension, drowsiness
Admin: Lots of drug-drug interactions!
Pt. Education: Oral hygiene!
Long term risks: Osteoporosis (drug interferes with vitamin D metabolism)

Question 11

cyclobenzaprine (Flexeril)

Answer 11

Class: Centrally Acting Skeletal Muscle Relaxants

Question 12

cyclobenzaprine (Flexeril)
MOA: 
Uses: 
AE:
Nursing implications:

Answer 12

MOA: Appears to produce relaxation by acting at the brainstem and spinal cord to depress motor activity
Uses: Muscle spasm
AE: Drowsiness, dizziness, anticholinergic effects (dry mouth, constipation, urinary retention, tachycardia)
Nursing implications: Monitor patient for sedation and provide good patient education

Question 13

dantrolene (Dantrium)

Answer 13

Class: Antispasmodic

Question 14

dantrolene (Dantrium)
MOA:
Uses: 
AE:
BBW:

Answer 14

MOA: Appears to reduce impulse transmissions from the spinal cord to the skeletal muscle
Uses: Spasticity in patients with MS, SCI, and other spinal cord diseases; can also be used for malignant hyperthermia (104/105 degree fevers develop in OR, under anesthesia, muscles become very rigid)
AE: Drowsiness, dizziness, weakness, fatigue, confusion, headache, insomnia, hypotension, urinary frequency
BBW: LFTs (liver function tests) need to be monitored before drug therapy and drug needs to be stopped at first indication that liver impairment is occurring (jaundice, drop in LFTs, etc.)